Wrist fusion: Radiolunate limited fusion with Acutrak headless screw
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This technique demonstrates the steps involved in fusing the radiolunate joint; while this particular procedure is niche, the principles involved (confirmation of the surfaces to fuse; preparation of the joint surfaces while preserving radiocarpal length; harvesting and inserting autologous cancellous bone graft to ensure bone-to-bone apposition; stabilising the fusion interface with compression of the joint surfaces) are universally applicable to fusion operations, and can be used in many other settings.
Wrist fusion operations are good at alleviating pain from arthritis, but at the expense of reducing motion. Given the large number of bones involved in the wrist joint, depending upon the pattern of joint involvement with the arthritis, there may be the option of fusing only selected joints, so retaining some motion while improving the patient’s pain. This technique describes fusion of the radiolunate joint, a procedure that has few indications in the treatment of osteoarthritis due to this articulation usually being spared in the earlier stages of arthritis, and so often other joints will need fusing instead / as well (e.g., radioscapholunate; total wrist fusion). However, aside from the relatively rare cases of isolated radiolunate arthritis, the procedure is useful in patients with inflammatory arthritis, where fusion of the lunate to the radius provides stability to the wrist, securing the central capito-lunate joint and with it mid-carpal motion. This allows preservation of motion while improving pain (and stabilising the remainder of the proximal carpal row).
Currently, most surgeons would prefer to offer a motion-preserving biological option over either a total wrist fusion or a wrist replacement procedure, although as the outcomes of wrist replacement surgery improve, there may be a change of practice towards having a lower threshold for offering wrist replacement with the more predictable outcomes in the short to medium term that arthroplasty offers.
To be successful, arthritis should be confined to the radiolunate joint, with preservation of the radioscaphoid and mid-carpal joint surfaces. The wrist should be mechanically stable, and free from infection.
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Author: Chris Little FRCS(Tr & Orth)
Institution: The Nuffield Orthopaedic Centre, Oxford, UK.
Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.